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Best-s elling anti-depressants like Prozac and Seroxat are barely more effective than placebos in treating most people with depression, a study led by a British university said Tuesday.

The research, which analysed 47 clinical trials, breaks new ground by incorporating data not previously released by drug companies which researchers obtained under US freedom of information laws.

Its findings prompted some academics and mental health campaigners to question whether people with mild and moderate depression should be prescribed drugs like Prozac, which has been taken by 40 million people worldwide.

"The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great," said Professor Irving Kirsch of Hull University, in northern England, who led the team.

"This means that depressed people can improve without chemical treatments.

"Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit."

The study, published in the journal PLoS (Public Library of Science) Medicine, looked at Prozac, Seroxat, Effexor and Serzone and found the drugs were only better than a placebo for some people with severe depression.

Kirsch's team said it was one of the most thorough probes into the impact of new generation anti-depressants or selective serotonin reuptake inhibitors (SSRIs).

But drug companies strongly questioned the findings....

Alison Cobb, of British mental health charity Mind, hailed the findings as "a serious challenge to the predominance of drugs in treating depression."

"Anti-depressants do help many people but by no means all and some people experience severe side-effects with them," she said.

"Nine out of 10 GPs (general practitioners) say they've been forced to dish out drugs because they don't have proper access to 'talking treatments' such as cognitive behavioural therapy, which are recommended as the first-line treatment for mild to moderate depression."

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Well, this explains a lot. After over a year of working with my psychiatrist to try different SSRIs for my depression -- to no avail -- I had sorta reached that conclusion on my own. All SSRIs have ever done for me is make me jittery and nervous (and make my dick go limp).

Now if I could just find something that would work.

Henry

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"Life in Lubbock, Texas, taught me two things: One is that God loves you and you're going to burn in hell. The other is that sex is the most awful, filthy thing on earth and you should save it for someone you love." - Butch Hancock, Musician, The Flatlanders

I'm exactly the same Henry. Furthermore, because they didn't work I was left wondering privately if I had some serious psychotic condition, and was fearful that if I admitted too much about SSRI failure they'd attempt to put me on some really strong med, which frankly I don't think I could handle.

I remember when my therapist wanted we to explore starting them when I was in the worst grip of my depression and I said no for philosophical reasons. Somehow I thought that it would deaden the pain that I was feeling and I need to feel in order to face it and get through it. Guess it wouldn't have made a difference.

I remember when my therapist wanted we to explore starting them when I was in the worst grip of my depression and I said no for philosophical reasons. Somehow I thought that it would deaden the pain that I was feeling and I need to feel in order to face it and get through it. Guess it wouldn't have made a difference.

Boy, everybody's completely ready to throw them out altogether. Not me. They've worked great for me.

Still, for some of you I am happy this bit of news has come along that they may not always be of benefit. Like for Henry...they help explain a lot. I'm still selfishly thrilled that I'm one of the ones they've helped.

Adding to the foregoing knowledgeable cooments I'll just say that the wholesale narcotizing of patients is just another example of attempting to do away with symptoms rather than the harder work of dealing with root causes of depression.

We cursed with living in a time in which the goal is always to "feel good" and experience instant gratification rather than taking the time that's needed to consider why something may not be working and respecting the feelings we have. The same thing with sleeping problems...just take another pill or two or however many rather than considering what might be going on both physically and emotionally that is affecting one's sleep.

Well said, Mr. Velez. I completely agree. I'm all for pills with HIV, but as far as mental issues go I'd prefer CBT. It's more work, and more time involved, but the ultimate dividend is hopefully longer lasting.

Well said, Mr. Velez. I completely agree. I'm all for pills with HIV, but as far as mental issues go I'd prefer CBT. It's more work, and more time involved, but the ultimate dividend is hopefully longer lasting.

I can totally relate to what you are saying here, Tim. For over a year now I've been working with therapists, and don't feel it has made a difference in my depression. In fact, I'd say it is worse. I would really like to deal with the root causes of my depression, rather than the symptoms, as Andy stated above. But heck, I'd settle for getting some relief from the symptoms via medications, if I could find any that worked.

All this is pretty timely, as it has been a rough day here for me. Crying at one's desk at work is not a good thing -- I'm glad I have an office door. The word "hopeless" just keeps coming into my mind, no matter how hard I try to banish it. I'm also glad that I have an appointment with my therapist tomorrow, if for no other reason than to have a conversation and say that what we have been doing so far just ain't working.

Henry

« Last Edit: February 28, 2008, 06:19:00 PM by BuckmarkTX »

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"Life in Lubbock, Texas, taught me two things: One is that God loves you and you're going to burn in hell. The other is that sex is the most awful, filthy thing on earth and you should save it for someone you love." - Butch Hancock, Musician, The Flatlanders

Anti-d's were a joke to me. Don't know how those things were approved by the FDA. Those side effects no one should have to deal with.I know they do work for some people I know personally that are bipolar. I would have done anything for a reduction of symptoms 3 months after diagnosis when I stopped eating and sleeping and was barely functional. I can't tell if therapy or just time healed my wounds or both but in the past month I've had a dramatic reduction of symptoms. Now if only the truvada and viramune didn't make me so EXHAUSTED...life would be even better!

I can totally relate to what you are saying here, Tim. For over a year now I've been working with therapists, and don't feel it has made a difference in my depression. In fact, I'd say it is worse. I would really like to deal with the root causes of my depression, rather than the symptoms, as Andy stated above. But heck, I'd settle for getting some relief from the symptoms via medications, if I could find any that worked.

Quoted as some gospel. "I'd like to spend this hour talking about how this is some bullshit."

There came a point (at least for me) when, well...I'd said it. I'd pretty much hashed and rehashed the "root issues" and such and came to my "reasonable mind" conclusion that sometimes things just suck and they always will suck. For example, like with me there was the whole gay issue and family bummer issue. It really upset me that it upset them that I was gay. It always had, it always will.

I'm coping, ok? I'm coping already...but it still sucks, ya dig?

So at that point, one tends to think perhaps a little helper pill might not be such a bad thing if it can bring relief. Especially since I also really and truly feel like I have a physiological/chemical imbalance dealie that just makes my emotions go up and down anyways.

It's kinda like Sysyphus saying, "OK. I'll continue to push the rock up the hill. But can I at least have some comfortable shoes?"

All this is pretty timely, as it has been a rough day here for me. Crying at one's desk at work is not a good thing -- I'm glad I have an office door. The word "hopeless" just keeps coming into my mind, no matter how hard I try to banish it. I'm also glad that I have an appointment with my therapist tomorrow, if for no other reason than to have a conversation and say that what we have been doing so far just ain't working.

Henry

Henry, you just hang in there sweetie. At least you're getting your emotions out.

I wouldn't give up on the idea of therapy. I understand some people need meds, but that coupled with a good therapist can be the ticket sometimes.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

The way I look at therapy is that, over 8 years, it's NOT cured me -- but I think going has prevented me from getting worse. I just look at it like a monthly check up now, because that's all I go is monthly.

However, when I first started therapy I went either weekly or every other week -- can't recall... and that period was definitely very constructive.

Actually I shouldn't say I've been in therapy for 8 years, because 4 years of that I was just going to a prescribing psychiatrist with no therapy sessions and frankly I just tread water and got a bit worse. My first year back in my current therapy was spent just making up for that lost time.

I'm not surprised at the study. Only thing that seems to work with these antidepressants are the horrible side effects. Then there is the spending of money on some therapists that are more screwed up than I am . Go figure

From a personal point of view I wasn't surprised to read this study - I've been on a lot of SSRIs and some of the atypicals and they've never done much for my mood - they have made me eat like a horse and make my anxiety levels spike and sometimes had no discernible effects at all. I think the U.K has a similar problem to the U.S and the whole of the Western world in that the big pharmaceutical companies tend to only publish positive results that make their product look good. There is a growing movement over here to legislate and make them publish everything, which I think would benefit patients enormously.

When I was studying pharmacology we had a league table of drug effectiveness in one lecture - measured in how many people you need to treat to "cure" somebody. The point was to show how ineffective most drugs are. SSRIs were pretty high up at 2 - meaning you had to treat two people to get one person to improve. The only drug they gave as an example of 1 was insulin in diabetic ketoacidosis - without insulin everybody dies, with it nobody. Incidentally, I think ARVs in people with low CD4 counts are probably another example of drugs in that ball park.

I haven't read this study, just the reports. But it's a pretty difficult thing to measure - most depression is self limiting and I also wonder what dosages of the drugs people were on, and how that was standardised. My experience of SSRIs was that they made my doctor feel better, but not me! I'm a big man, but really had to push to get my dose upped from the minimum. I think a better approach in patients with moderate/severe depression is to start near the top, get it under control and taper down - then you get a quick improvement if it's going to happen, and if it's not you know to try something else - it's sickening wasting time for months on something that's not going to help.

I totally agree with Andy about how being miserable is part of the normal spectrum of feeling and has been overly medicalised. I'm a lot more tolerant of feeling crap these days, and it is actually shorter that way and easier to get through. I don't take anything now, but I'm lucky to be in a subsidised analysis (still costing me £200 a month) for the last two years, which gives me some support every day. But I feel sorry for doctors when they have a patient in tears in their consulting room and the wait for some kind of therapy is 6 months to 2 years - what else have they got to offer other than anti-depressants?

Another opinion here from another POV. I am a therapist at a private non-profit community mental health clinic. I have about 50 patients at any given time. Most are depressed and most--but not all take antidepressants. It's been my experience that anti-depressants and other neuroleptic medications work great for about a third of the patients, seem to help another third somewhat and do nothing at all for about a third. Side effects vary greatly and range from tolerable to intolerable. Meds alone tend to be far less effective than meds and psychotherapy combined. I have a number of patients that nothing seems to work for in terms of medications. BUT then I have a rather jaundiced opinion about most prescribers and their knowledge of the full menu of drugs or the willingness to try them. SSRIs are not the only game in town but then they are the ones almost always tried first--partly for liability reasons because they are less toxic when OD'd on.

I started on Wellbutrin myself almost a month ago at the suggestion of my MD. Cant see that I experience any effect at all. I may just bag it when my script runs out. I do not see myself trying an SSRI. My co-pay for a month's RX was $45. Regards to you all.

I've notice over the last 15 years my clinic has been trying to push antidepressants on me. I've often wondered if its just me or do they do this to all positive people.

I even went to see their in office shrink once after either my husband or my son died. <can't remember which one>No offense to the man I spoke to but I just didn't get anything out of it. When people you love die its natural to feel sad. I told the guy that but he didn't seem to be impressed with my rational. He insisted on the magic pill cure and gave me some script, I cant even remember the name of the drug. I took one pill. Had what felt like an electrical storm go thru my body. Promptly freaked my ass out and flushed the rest of the pills down the toilet.

After that I decided I wasn't going to take any of their Dr. Feel Good pills. Sure I've been thru alot of crap that has likely screwed me up psychologically but I deal pretty well I think. I'm only a fruitcake on rare occasions. LOLI don't think happy pills would do anything to resolve the underlying causes of my problems.

Anyway, I back peddled and decided to try the last antidepressant they offered me. This time it wasn't for depression but supposedly this magic pill <Amitriptyline> was going to make my intestinal pain go away. I have intestinal pain 24-7. I just deal with it. They cant tell me whats wrong with me they just guess. So far this magic pill hasn't done crap for my pain but it sure helps me sleep at night. I'm a light sleeper and a bit of an insomniac. So I'll continue to take them...

I've been on antidepressants of the reuptake inhibitor type for 15 years. I've been with them and without them, and i prefer with. I think anyone whose used them with some consistency knows that they are a bit more than "sugar pills". Many times for me they have meant the difference in being able to function and not. This reminds me- gotta go take a pill..as my b/f chides me: "Take your nerve pill, Grandpa!"

I'm starting to realize there may be more to antidepressants than just sugar pills. When I am off them I am more depressed. When I am on them I feel more focused. I guess the meds effect people differently. Unfortunately they all have side effects too. I don't like the side effects. But what can we do. Nothing is Utopia I guess.

No don't have that problem yet Philly :-). But antidepressants definitely decrease my sex drive. Which at times can be a good thing. Gives me a chance to focus on other things. Besides if I feel like I want to be more sexual I find if I miss a few days of antidepressants the sex drive is back. I'm single and not dating right now so don't really have a need for a big sex drive at the moment.

Today, April 10th, is one of those days that I feel like I may as well throw my Bupropion in the trash can. It has not done a BIT of good, I have had a really down day. I tend to be hard on myself anyway; add a good downer of depression to that and it can make for a tough day.

Maybe I do agree with the study, that antidepressants are useless...

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"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

-Sorry you had a down day. Hope it gets better.Wellbutrin (bupropion) targets dopamine primarily, with norepinephrine and seratonin secondary effects. For depression it is usually used together with an SSRI like venlafaxine, prozac, etc. Often Wellbutrin is precribed in conjunction with other anti-depressants because the increased dopamine levels help counteract the decreased libido that can come from seratonin reuptake inhibitors.If the bupropion isn't helping, I would talk to a dr. about something else.

Adding to the foregoing knowledgeable cooments I'll just say that the wholesale narcotizing of patients is just another example of attempting to do away with symptoms rather than the harder work of dealing with root causes of depression.

I agree with you in so far that I think that no one should receive SSRI as the only treatment. At best it will only hide the underlying problem, at worst the side effects can contribute to a suicide.

However, due to several different circumstances I became very depressed just over a year ago. I met with my clinic's psych consult and he recommended SSRI and even though I've always been sceptical of SSRI he convinced me to try it out and he also referred me to a psyciatrist.

As it was summer time I had to wait for the psyciatrist appointment so I started using SSRI (in my case Citalopram/Celexa) and I found that it stopped me from getting into the really "black" states of mind which I think makes it worth taking.

However, without help from a psychotherapist and a mental health councellor (pls forgive me if I'm using incorrect English terms) I would never have been able to make the necessary changes in my life and in my way of thinking about things which were necessary for me to be able to start recovering from the depression.

I found that it stopped me from getting into the really "black" states of mind which I think makes it worth taking.

That's true for me too. Antidepressants aren't going to "make you happy", but they can knock out the deepest end of depression, the part that makes you non-functional. I think depression is a lot about ideas and behaviors too, so there should definitely be some cognitive behavioral therapy in the mix.

As a mental health professional, I have worked with many people on anti-depressants and I have recommended them to some. I have had clients say that they were life savers, and had others say that they felt numbed out on them, that the medications eliminated the emotional lows but also the emotional highs of life, if you will, and that they would rather deal with the lows through other means so that they then could also experience the highs.

In all honesty, what I have found in my own extensive personal and professional experience is that most people want to take the medications as a way to deal with the PROBLEMS instead of to deal with the SYMPTOMS. Most people would rather take a pill than allow themselves to feel the immense sadness that can result from the death of someone close to them, or to leave a job that they abhor but which pays extremely well, or to end a relationship that has become much more like habit than any semblance of real intimacy. Thatís the American/Western way, isn't it, to pop a pill for every little ill? We don't want to feel our feelings, or take the time required to do so, for whatever reasons: finances; stigma; family responsibilities; the list could go on and on and on. Nevertheless, the medications were designed to treat symptoms that have persisted too long or are particularly debilitating and therefore impede oneís ability to address the problem, and NOT to treat the problems themselves. In my opinion, that is exactly how they should be used.

Another recent study suggested that the newer anti-depressants are in fact only slightly more effective, if at all, than the older ones. (Please don't ask me for references. I would have to google it too, just like you. <g>) There was also a huge meta-analysis performed recently of decade's worth of studies of all or most of the drugs, and included a critical look at the very data that the pharmaceutical companies used to pursue government approval. It was discovered that big pharma selectively submitted results from their own research as well as twisted the results that they did submit, in order to make anti-depressants seem significantly more effective than they actually are. (How shocking!)

Other research has shown that people with depression (and other "typical" mental health challenges) who use only talk therapy get well and feel better within the same time frames as people who take anti-depressants. Six months seems to be the average, no matter what treatment you choose. Yes, I know that this begs the question: is it possible that everyone would get better regardless within the six months, then, with or without intervention of any kind; however, it is not within the parameters of this particular posting for me to muse on that issue!

I have taken a few of these medications myself. I took Paxil about 7-8 years ago for perhaps a year, when a series of events in my life cascaded into disaster (in short, I lost several close friends, my job, my income, my housing, and probably a few other things, all at once - and no, it wasn't due to drug abuse or addiction) and I found myself psychologically devastated. I didn't feel like it had much effect on my mood, frankly, or my sex drive and ability to perform in the sack, but I stayed at a pretty low dose.

Then I used Trazodone, which is often prescribed as a non-narcotic sleep aid and not for its anti-depressant effects, and is known to have an extremely low incidence of side effects. I took it because when I was taking sustiva 600 mg at night it felt like my brain forgot to sleep. I think at a regular dose, Trazodone did help me sleep another hour or so at night, but in the long-term it wasn't enough (from 4-5 hours to 6-7 and all the time fatigued anyway) and I had to change my sustiva dosing. Other than getting a bit more sleep, I didn't note any other effects of the medication: anticipated, side or (later) withdrawal. I might have even used Wellbutrin at one point for smoking cessation but I don't really remember, so there's no point in babbling on about that. (The drug company gives the EXACT SAME DRUG a different brand name when they are marketing it for smoking cessation. Another shock!)

Having said all this, it is important to note that lots of factors can influence feelings of depression: HIV in itself can be depressing, as can low testosterone (in men and women, which can also be caused by HIV), and so can not sleeping. On top of that, almost every single criterion for a diagnosis of depression can be a symptom of something else, including totally normal sadness and grief.

Some of my clients would see their psychiatrists periodically to pursue the often endless chore of cycling through every known anti-depressant instead of confronting the circumstances or events which lead to their depression in the first place. For the chronically depressed, it could be compared to HIV-ers having to switch meds when the virus develops resistance, because usually whatever anti-depressant the patient is taking stops working after some years and he or she has to try other ones in order to continue to medicate the symptoms. I think itís critically important to note that HIV and AIDS can without a doubt be chronic mental health challenges, requiring on-going medication to address those symptoms. Just like I said earlier, thatís what the medications were designed to do.

Chemical imbalances can result from the way that we behave and feel and think and from what we put in our body (why do you think you can't drink something as simple as grapefruit juice with some HIV medications?), just as they can result from other factors that then influence the way we think and feel and behave. And you can often "cure" the imbalance by changing the way you think and feel and behave, just like you can "cure" the imbalance by popping a pill.

But good public relations and advertising go a long way, donít they? And afterwards it is hard to unbrainwash the brainwashed. Besides, the placebo effect is extremely powerful and poorly understood (the "On Science" article in the 3/17/08 issue of ďNewsweekĒ magazine, which refers to some of these same studies, was quite interesting). In a sense the studies showing little to no effectiveness on the part of anti-depressants "don't really matter"; if a patient thinks it is helping, it is. Right? :-)

In a sense the studies showing little to no effectiveness on the part of anti-depressants "don't really matter"; if a patient thinks it is helping, it is. Right? :-)

To quote the article the op linked to, "The results showed the drugs were effective only in a very small group of the most extremely depressed." This speaks of populations, not individuals. It does not say that antidepressants are mostly useless for any particular person. Rather, the drugs are either effective for you or they are not. So the "Mostly Useless" title of the article is the kind of misleading sensationalism published by popular news magazines. No medical journal would say that the study shows that antidepressants are mostly useless. It would say exactly what the study concludes: that they are effective only for a small population.Furthermore, I find the idea that "if a patient thinks it is helping, it is" just plain wrong, especially coming from a mental health professional. Surely you agree that what a patient thinks of their condition does not change that condition. If a patient feels better, then yes, he feels better. But if a patient attributes that improvement to a drug, that in itself does not mean the drug is helping. This is simple logic. Believing that dogs give birth to cats does not make it so.

Furthermore, I find the idea that "if a patient thinks it is helping, it is" just plain wrong, especially coming from a mental health professional. Surely you agree that what a patient thinks of their condition does not change that condition.

You obviously don't know about the power of the mind. I find that with most people, if they take a pill and feel better, while it may not change their condition, it sure changes their perception of how they're feeling physically and mentally. No one ever said that how someone feels erases their original condition. I think you may be reading things into this that aren't there.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

No one ever said that how someone feels erases their original condition. I think you may be reading things into this that aren't there.

No, I am reading it for what is it. It is only poor thinking skills that would cause anyone to agree with the statement that "if a person thinks it is helping, then it is". The drug is either effective (i.e. helps you) , or it isn't. Your belief might help you, and/or the drug might help you, but believing that the drug helps you does not make it so.If I believe that I am no longer depressed, yet still have the troublesome symptoms of depression, then I am still depressed, no matter what it is I believe.Mental health workers encounter this all the time. Someone might believe that cutting themselves/smoking crack/beating their kid/take your pick is a good thing. The fact remains that it is not, no matter what they believe.Likewise, the drug is either effective or it is not, according to this study. No amount of "believing" that the drug is working will make it work, if indeed it doesn't.It's also completely inaccurate to say they are "mostly useless" for you if they are ineffective for you. Ineffective means they don't help relieve your depression. If they don't help you, then how are they mostly useless? if they don't help you, then they are simply useless for you. The "mostly useless" phrasing of the article's title is, as I said, misleading hyperbole conjured to sell magazines.You say that I obviously do not know about the power of the mind. I have degrees in psychology and linguistics, and I teach logic and critical thinking, so it happens that I do know something about the power of the mind. However, I also know that thinking something is so does not make it so. For centuries, people believed that the earth was flat. Does that mean it was? if i believe a drug is helping, does that mean the drug is helping? Of course not! That does not mean the drug is NOT helping, the point is simply that my belief is insufficient. My god, could you imagine how the entire scientific enterprise would CRUMBLE is we said things were so simply because we believed it, without any empirical evidence to back up our assertions? That's precisely what the creationists do!

Chm02, I know several people with degrees in psych, and I don't take just one of them for their word. In other words, I suppose we're all entitled to our own opinions and just because you say it's so, well, it doesn't make it so.

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I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Chm02, I know several people with degrees in psych, and I don't take just one of them for their word. In other words, I suppose we're all entitled to our own opinions and just because you say it's so, well, it doesn't make it so.

Well of course everyone is entitled to their own opinion, but that doesn't mean that any opinion is as good as another.There are rigorous, reasoned opinions and flabby, mostly useless ones.What upsets me so about the misleading article is the missing premise that it asks us to create. Between the conclusion of the data analysis (Antidepressants are effective only for a small population) and the conclusion of the article that reports the data analysis' conclusion (Antidepressants are mostly useless), there is a missing premise - a statement that allows us to link the two otherwise unrelated conclusions. I wonder if you can guess what it is....________________________________